Nonalcoholic Steatohepatitis and Liver Transplantation

The growing epidemic of obesity has led to an increase in the number of patients developing end-stage liver disease related to nonalcoholic steatohepatitis (NASH). In fact, NASH is now the second-leading etiology for liver transplantation in the USA. In this context, interest is growing in understanding the outcomes of liver transplantation in patients with NASH. Current data suggest that the short- and medium-term outcomes for NASH patients post-transplantation are not different from those for other recipients. Nevertheless, patients with NASH and diabetes may have higher risk post-transplantation for de novo diabetes. Caregivers must be vigilant post-transplant for the development of de novo diabetes regardless of their pre-transplant status. NASH patients also seem to have a lower functional status post-transplant. There are conflicting data regarding the outcome of morbidly obese patients with NASH who undergo liver transplantation. The pre-transplant management of these patients with surgical weight loss is reported, but caution must be exercised in considering them for transplant.